Pain During Sex: Causes and When to See a Doctor

It is genital or pelvic pain linked to sex. It can be felt in the vulva, at the vaginal opening (the vestibule), inside the vagina, in the pelvis or in the lower back.

In the Natsal-3 survey (Mitchell and colleagues, *BJOG*, 2017) of 6,669 sexually active women aged 16 to 74, 7.5% had had painful sex for three months or more in the past year. For one in four of them, the pain was very frequent, lasted six months or longer and caused distress. It was most strongly linked with vaginal dryness, anxiety about sex and lack of enjoyment, and also with depressive symptoms and non-consensual sex.

You feel it as penetration begins, when inserting a tampon or when the vulva is touched.

• Dryness and low arousal. Without enough arousal there is little lubrication. Breastfeeding, some hormonal contraceptives, certain antidepressants and perfumed soaps also play a part. See how to choose a lubricant.
• Infections. Thrush causes white discharge, itching and stinging during sex; it is not a sexually transmitted infection (STI), although sex can trigger it. Genital herpes causes blisters that leave painful sores. Trichomoniasis can make sex unpleasant. Chlamydia can cause lower tummy pain and bleeding after sex.
• Skin conditions. Lichen sclerosus causes itchy white patches that are easily damaged; over time it can narrow the vaginal opening.
• Vestibulodynia and vulvodynia. Vulval pain lasting three months or more with no other cause: burning, stabbing or stinging. When only the vestibule hurts on touch, it is called provoked vestibulodynia.
• Vaginismus. The muscles at the entrance tighten on their own when something is inserted. It is a reflex, not a choice.
• Genitourinary syndrome of menopause. With less oestrogen, the vaginal lining lubricates less. There may be stinging, needing to pee more often and light bleeding after sex. More in sexuality during menopause.
• After childbirth. An episiotomy or a tear can hurt for several months, and breastfeeding adds dryness. See the pregnancy and postpartum guide.

It comes with deep penetration or in certain positions.

• Endometriosis. Tissue similar to the lining of the womb grows outside it. It often causes very painful periods and pain during or after sex. Diagnosis can take years.
• Pelvic inflammatory disease. An infection of the womb, fallopian tubes and ovaries, usually caused by chlamydia or gonorrhoea. It causes deep pain during sex and unusual discharge. Antibiotics cure it, but untreated it can affect fertility. Check how often to get tested for STIs.
• Adhesions and other causes. Scarring from pelvic surgery, ovarian cysts, fibroids, cystitis or irritable bowel syndrome.

• Short frenulum: the band of skin under the head of the penis pulls during erection and can tear and bleed.
• Phimosis: the foreskin will not pull back and erections hurt.
• Balanitis: the head of the penis becomes inflamed from thrush, an STI or irritation from soaps or condoms.
• Chronic prostatitis: pain in the penis, testicles or on ejaculation for three months or more.
• Peyronie's disease: a hard plaque makes the erect penis curve and can make erections painful.

You can see a GP, a gynaecologist, a urologist or a sexual health clinic.

1. Questions: where and since when it hurts, whether at the start or deep inside, your periods, births, medicines and how you feel about sex.
2. Examination: the area is looked at and sometimes touched gently with a cotton bud to find the painful spots. You can ask for a female clinician, bring someone with you or ask them to stop at any time.
3. Tests: swabs for infections, blood or urine tests, an ultrasound and, if endometriosis is suspected, an MRI or laparoscopy.

Warning signs

Get urgent help if you have:

• severe, sudden or worsening pelvic pain with fever, dizziness or vomiting;
• pain with heavy vaginal bleeding;
• severe penile pain after a knock during sex, or a foreskin stuck behind the head of the penis.

Book an appointment soon if you bleed after sex or after menopause, have sores or unusual discharge, or the pain keeps coming back.

Pelvic floor physiotherapy has good evidence. In a trial of 212 women with provoked vestibulodynia (Morin and colleagues, 2021), ten weeks of physiotherapy reduced pain during penetration more than an anaesthetic cream. 79% felt much better, compared with 39%, and the improvement held at six months.

Sex therapy or psychological therapy helps break the cycle of fear, tension and pain.

• "It's normal for it to hurt; you just have to put up with it." No. Putting up with it reinforces tension and fear.
• "It's all in your head." Emotions play a part, but many causes are physical, and they often overlap.
• "Thrush is an STI." It is not, although sex can trigger it.
• "No symptoms means no infection." About seven in ten people with trichomoniasis notice nothing.

To control depth and pace, carry on with our guide Pelvic health and pain relief.

*How we write our content: see Safety and evidence.*